Exhibit 14 - Declaration of Karl Eschbach, Ph.D.

8/10/2019 Exhibit 14 - Declaration of Karl Eschbach, Ph.D.

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EXHIBIT 14

pp. 0749


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1

IN THE UNITED STATES DISTRICT COURT

FOR THE SOUTHERN DISTRICT OF TEXAS

BROWNSVILLE DIVISION

STATE OF TEXAS, et al., ))

Plaintiffs, )

)

v. ) Civil Action No. 1:14-cv-00254

)

UNITED STATES OF AMERICA, et al., )

)

Defendants )

DECLARATION OF KARL ESCHBACH,Ph.D.

My name is a!l "sc#$ac#, and % am ove! t#e a&e of 1' and f(lly cometent in

all !esects to ma*e t#is decla!ation. % #ave e!sonal *no+led&e and ee!tise of t#e

matte!s #e!ein stated.

I. Qualifia!i"#$

1. % am a demo&!a#e!, +it# a P#.D. f!om t#e dea!tment of sociolo&y at

a!va!d nive!sity /12), and a ost-docto!al t!ainees#i in demo&!a#y

sonso!ed $y t#e National %nstit(te of C#ild ealt# and (man Develoment at

t#e nive!sity of isconsin, Cente! fo! Demo&!a#y and "colo&y /1-15). % am

P!ofesso! and Di!ecto! of Po(lation 3esea!c# at t#e nive!sity of eas Medical

!anc# in 6alveston, eas.

2.

My !esea!c# seciali7ations a!e in t#e a!eas of !acial and et#nic

demo&!a#y and #ealt# disa!ities, +it# a a!tic(la! foc(s on isanic and t#e

Ame!ican %ndian o(lations. % #ave ($lis#ed ee!-!evie+ed !esea!c# a!ticles on

ille&al mi&!ation and on #ealt# and #ealt#ca!e (se amon& immi&!ants. % #ave

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se!ved as t#e elected C#ai! of t#e Ca(c(s of 3ef(&ee and %mmi&!ant ealt# in

association +it# t#e Ame!ican P($lic ealt# Association, and #ave se!ved $y

aointment of t#e 8ec!eta!y of 9ete!ans Affai!s on t#e Dea!tment of 9ete!ans

Affai!s ealt# 8e!vices 3esea!c# and Develoment 8cientific Me!it 3evie+ oa!d,

+it# a !incial assi&nment to eval(ate !oosals e!tainin& to o(lation

disa!ities in #ealt# ca!e (se and o(tcomes. % +as aointed $y 6ove!no! 3ic* Pe!!y

to se!ve as t#e 8tate Demo&!a#e! of eas, and #eld t#is osition f!om 200' to

2010. As t#e 8tate Demo&!a#e!, % #ad a stat(to!y !esonsi$ility to advise t#e

le&islative and eec(tive $!anc#es of t#e 6ove!nment of eas on t#e imlications

of demo&!a#ic t!ends on 8tate se!vice demands. As a!t of t#ese d(ties, % !evie+ed

c(!!ent info!mation a$o(t t#e vol(me of (na(t#o!i7ed mi&!ation to t#e state of

eas.

.

Attac#ed to t#is decla!ation a!e t!(e and co!!ect coies of t#e follo+in&

doc(ments:

Aendi 1 incl(des my c(!!ic(l(m vitae and lists my ($lications in t#e last

ten yea!s.

Aendi 2 sets fo!t# t#e cases in +#ic# % #ave testified in deosition o! at t!ial

d(!in& t#e last fo(! yea!s.

II. S"%& "f I#'ui()

4.

% #ave $een !etained in t#is case $y t#e ffice of t#e Atto!ney 6ene!al

of eas to analy7e t#e follo+in& t#!ee iss(es: /1) +#et#e! t#e 2012 Defe!!ed Action

fo! C#ild#ood A!!ival /DACA) !o&!am ca(sed an inc!ease in t#e (na(t#o!i7ed

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immi&!ant o(lation, and +#et#e! t#e 2012 Defe!!ed Action fo! Pa!ental

Acco(nta$ility /DAPA) !o&!am li*ely +o(ld ca(se a concomitant inc!ease in t#e

(na(t#o!i7ed immi&!ant o(lation; /2) t#e met#od fo! co(ntin& t#e (na(t#o!i7ed

immi&!ant o(lation and t#e n(m$e! of (na(t#o!i7ed immi&!ants t#at !eside in

eas; and /) +#et#e! (na(t#o!i7ed immi&!ants !eceive a dis!oo!tionate amo(nt

of (ncomensated #ealt#ca!e.

III. Su**a() "f O%i#i"#$

5.

ased on my ed(cation, (stment of stat(s. As

a !es(lt, t#e n(m$e! of (na(t#o!i7ed immi&!ants +ill inc!ease in t#e

nited 8tates $y ma*in& self-deo!tation a less att!active otion. 8econd,

t#e DAPA !o&!am +ill li*ely ma*e it mo!e att!active fo! (na(t#o!i7ed

immi&!ants to mi&!ate to t#e nited 8tates. 6iven t#at t#e DAPA !o&!am

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is t#e second time t#e &ove!nment #as offe!ed defe!!ed action stat(s to a

class of (na(t#o!i7ed immi&!ants and #as !ovided t#em +o!*

a(t#o!i7ations, individ(als may $e enco(!a&ed t#at if t#ey ente! t#e nited

8tates ille&ally, t#e &ove!nment +ill &!ant t#em t#e same $enefits in a

f(t(!e !o&!am. %t is t#e!efo!e !easona$le to concl(de t#at +it# t#e

imlementation of t#e DAPA !o&!am, ot#e! t#in&s e(st as

+as !esent ost-DACA.

$.

%t is my oinion t#at t#e lo+ !ates of !ivate ma!*et #ealt# ins(!ance

cove!a&e fo! (na(t#o!i7ed immi&!ants !esidin& in t#e nited 8tates, as

+ell as t#ei! ecl(sion f!om cove!a&e f!om most ($lic !o&!ams and f!om

ma!*et ec#an&es (nde! t#e Affo!da$le Ca!e Act !es(lt in dis!oo!tionate

(se of (ncomensated ca!e, !es(ltin& in a s($stantial $(!den on states and

s($-state >(!isdictions +it# #eavy !e!esentation of (na(t#o!i7ed

immi&!ant o(lations.

#e $asis fo! eac# of t#ese findin&s is elained in mo!e detail $elo+.

IV. C"u#!i#+ !h& U#au!h"(i&- I**i+(a#! P"%ula!i"#

?.

=ollo+in& t#e imlementation of t#e %mmi&!ation 3efo!m and Cont!ol

Act /%3CA), t!ends in !esident (na(t#o!i7ed o(lations #ave $een st(died (sin& a

!esid(al met#odolo&y to infe! t#e si7e and c#a!acte!istics of t#e (na(t#o!i7ed

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5

o(lation $y s($t!actin& t#e *no+n le&ally !esent immi&!ant o(lation f!om t#e

total immi&!ant o(lation estimated f!om nited 8tates Cens(s (!ea( s(!veys.1

@.

#is met#odolo&y #as &ained +ide accetance amon& demo&!a#e!s and

immi&!ation sc#ola!s. Conco!dant estimates of t#e !esident (na(t#o!i7ed o(lation

#ave $een !e&(la!ly !od(ced (sin& t#is met#odolo&y $y t#e statistics office of t#e

Dea!tment of omeland 8ec(!ity,2and $y t#e Pe+ isanic Cente!, a non-!ofit

!esea!c# instit(te. A !et!osective ann(al time se!ies fo! t#e e!iod f!om 10 to

2010 +as ($lis#ed as ee!-!evie+ed !esea!c#.4

'.

a$le 1 $elo+ s#o+s t#at t#e estimates of t#e si7e of t#e (na(t#o!i7ed

o(lation !od(ced in t#ese t#!ee imlementations of t#e !esid(al met#odolo&y a!e

#ily conco!dant.

1 3o$e!t a!!en Beff!ey 8. Passel, A Count of the Uncountable: Estimates of

Undocumented Aliens Counted in the 1980 United States Census, 24 D"M63AP @5

/1'@); =!an* D. ean et al., The Quantification of Migration et!een Me"ico and the United

States, in 1 M%63A%N """N M"%C AND " N%"D 8A"8:%NA%NAE 8D1-'

/Meican Minist!y of =o!ei&n Affai!s .8. CommFn on %mmi&!ation 3efo!m, 1').2!yan a*e! Nancy 3ytina, DeFt of omeland 8ec(!ity, ffice of %mmi&!ation

8tat., Estimates of the Unauthori#ed $mmigrant %o&ulation 'esiding in the United States:

(anuar) *01*/201). Beff!ey 8. Passel DF9e!a Co#n, Pe+ 3esea!c# Ct!. isanic !ends P!o>ect,

Unauthori#ed $mmigrant Totals 'ise in + States, -all in 1./Nov. 1', 2014).4 3o$e!t a!!en Bo#n 3o$e!t a!!en, Unauthori#ed $mmigration to the United

States: Annual Estimates and Com&onents of Change, b) State, 1990 to *010, 4@ %NFE

M%63A%N 3"9. 2? /201).

pp. 0754


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?

Tal& /0 E$!i*a!&- U#au!h"(i&- I**i+(a#! R&$i-! P"%ula!i"# u$i#+ !h&

R&$i-ual M&!h"-, 1 S"u(&$, f"( S&l&!&- 2&a($

ea!

Dea!tment of

omeland 8ec(!ity

Pe+

isanic

Cente! a!!en a!!ennited 8tates

10 Na na .500

2000 '.4?0 '.?00 '.?00

200@G 11.@'0 12.200 11.'1

2010 11.50 11.400 11.@25

2012 11.40 11.200 Na

201 Na 11.00 Na

eas

10 na na 0.4402000 1.00 1.050 1.12@

200@G 1.?'0 1.550 1.?1?

2010 1.@@0 1.?50 1.?0'

2012 1.'0 1.?50 Na

8o(!ces: a*e! 3ytina, su&ranote 2; a!!en a!!en, su&ranote 4; Passel Co#n,

su&ranote .

G200@ is t#e ea* yea! to date fo! t#e (na(t#o!i7ed o(lation of t#e nited 8tates in all

t#!ee estimate se!ies, +it# s($se


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@

V. Th& I#flu& "f DACA a#- DAPA "# U#au!h"(i&- I**i+(a#!

Mi+(a!i"# Pa!!&(#$

10.

o conside! t#e effect of DACA and DAPA, it is imo!tant to d!a+ on a

concet(al (nde!standin& of #o+ t#ese olicies a!e li*ely to affect t#e $e#avio! of

(na(t#o!i7ed immi&!ants. na(t#o!i7ed mi&!ation is a !ocess t#at occ(!s ove! time

!at#e! t#an a fied event. Potential (na(t#o!i7ed mi&!ants face an initial decision

a$o(t +#et#e! to ma*e an (na(t#o!i7ed ent!y. 8($seo$-secific s*ills.5

11. #e most imo!tant facto!s infl(encin& t#ese c#oices a!e li*ely to $e

$ased on !elative +a&es and >o$ oo!t(nities in t#e nited 8tates and in t#e co(nt!y

of o!i&in.? %mmi&!ation olicies, incl(din& t#e level of $o!de! and +o!*lace

enfo!cement, also !e!esent one facto! t#at infl(ences an individ(alFs decision

+#et#e! to mi&!ate o! not to mi&!ate to t#e nited 8tates.7

5Do(&las 8. Massey !istin ". "sinosa, /hats ri2ing Me"ico3U4S4 Migration5 A

Theoretical, Em&irical, and %olic) Anal)sis, 102 AM.B.8C. /1@).?6o!don . anson, $llegal Migration from Me"ico to the United States, 44 B."CN.

E%"3A3" '? /200?); 6o!don . anson Antonio 8ilim$e!&o, $llegal $mmigration,

order Enforcement, and 'elati2e /ages: E2idence from A&&rehensions at the U4S43Me"ico

order, ' AM."CN.3"9. 1@ /1).@ Catalina Am(edo-Do!antes et al., 6o! o Tougher $mmigration Measures Affect

Unauthori#ed $mmigrants5, 50 D"M63AP 10?@ /201); Pia M. !!eni(s Madeline

Havodny,o Amnest) %rograms 'educe Undocumented $mmigration5 E2idence from $'CA,

40 D"M63AP 4@ /200); anson 8ilim$e!&o, su&ranote ?.

pp. 0756


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'

12. #e dynamism of t#e (na(t#o!i7ed immi&!ant o(lation is !eflected in

t#e follo+in& ta$le:

Tal& 30 E$!i*a!&$ "f !h& T"!al U#au!h"(i&- I**i+(a#! P"%ula!i"# "f !h& U#i!&-

S!a!&$ a#- A##ual C"*%"#!$ "f P"%ula!i"# Cha#+&0 /445635/5

Met#od of Eeavin& t#e Po(lation

ea!

na(t#o!i7ed

%mmi&!ants,

Ban. 1

/1)

Ann(al Net

C#an&e

/2) I /) J /4)

"nte!ed

t#e

Po(lation

/)

Eeft t#e

Po(lation

/4) IK /5 to ')

"mi&!ated

/5)

Ad>(sted

to

Ea+f(l

8tat(s

/?)

3emoved

$y D8

/@)

Died

/')

2010 11,@25

200 11,' /1@4) '4 55' 24 104 1?5 4?

200' 12,00 /110) 4 54 252 100 150 4?

200@ 11,'1 2@ 55' 51 25' 4 1 4?

200? 11,@14 2?@ @4 4'2 25? ?4 11@ 45

2005 11,1@ @ '@ 4@? 250 @ 10 442004 10,@' '1 4@4 24@ '4 100 42

200 10,?2 2'? @@ 4 244 120 '' 41

2002 10,25 44 0? 4@ 2@ 115 '1 40

2001 ,?20 ?' 1,14? 50' 22 1@? @1 @

2000 ',?00 1,020 1,' ? 1' @ ?5

1 @,'2@ @@ 1,12 5' 1' ?0 ?5 5

1' @,210 ?1? 54 ' 1'2 ?1 ?5 0

1@ ?,@? 44' @5 11 1@0 54 5 2'

1? ?,21 4@2 @5? 2'4 1?1 55 41 2?

15 5,@20 5@1 '22 251 150 42 ? 24

14 5,25 4?@ @00 2 1' ' 5 22

1 4,25 2@ 55@ 22 10 45 4 20

12 4,5'@ 55 220 124 4 4 1

11 4,15 452 ?4 1@ 11? 5 2 1@

10 ,500 ?5 '1? 1'1 10 ' 25 15

8o(!ce: a!!en a!!en, su&ranote 4.

1.

#is ta$le s#o+s t#at t#e (na(t#o!i7ed immi&!ant o(lation !eflects

not only ne+ a!!ivals $(t also fo(! +ays in +#ic# eole leave t#e o(lation: /i)

emi&!ation o! vol(nta!y self-deo!tation; /ii) ad>(stment to la+f(l stat(s; /iii)

!emoval; and /iv) mo!tality.

14. DACA and DAPA !e!esent imo!tant olicy c#oices t#at oe!ate $y

defe!!in& enfo!cement action in +ays t#at inc!ease eli&i$ility to +o!* and allo+

individ(als to !emain in t#e nited 8tates +it#o(t fea! of immediate deo!tation.

pp. 0757


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#e DACA !o&!am, +#ic# +as initiated $y P!esident $ama in B(ne 2012, allo+s

ce!tain (na(t#o!i7ed immi&!ants +#o ente!ed t#e co(nt!y $efo!e t#ei! siteent#

$i!t#day to !eceive +o!* a(t#o!i7ation and eemtion f!om deo!tation. At t#e

initiation of t#is !o&!am, t#e Pe+ 3esea!c# Cente! estimated t#at ( to 1.@ million

eole mit $e eli&i$le fo! t#e DACA defe!!ed action stat(s.' %t is my (nde!standin&

t#at as of Decem$e! 1, 2014, 8C%8 #as &!anted DACA stat(s to a$o(t ??,000

individ(als.

15.

%n Novem$e! 2014, P!esident $ama anno(nced t#e DAPA !o&!am,

(!o!tedly aimed at !ed(cin& (na(t#o!i7ed immi&!ation at t#e $o!de!. Amon& t#e

initiatives incl(ded in t#e eec(tive action, t#e ne+ olicy +o(ld allo+ a!ents of

nited 8tates citi7ens and la+f(l e!manent !esidents +#o #ave $een !esent in t#e

co(nt!y since Ban(a!y 1, 2010 to !e


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immi&!ants al!eady !esent in t#e nited 8tates. As to eac# of t#ese cate&o!ies,

DACA and DAPA c#an&e t#e calc(lation of $enefits associated +it# comin& to, o!

!emainin& in, t#e nited 8tates.

1@. =o! t#ose individ(als di!ectly cove!ed $y DACA and DAPA, t#e olicies

inc!ease t#e si7e of t#e (na(t#o!i7ed o(lation insofa! as t#ey defe! t#e deo!tation

of (na(t#o!i7ed immi&!ants +#o meet ce!tain eli&i$ility c!ite!ia and +#o +o(ld

ot#e!+ise #ave $een identified $y t#e Dea!tment of omeland 8ec(!ity and s($>ect

to deo!tation +it#in t#e time e!iod secified in t#e !o&!ams.10 A second

(nam$i&(o(s effect is t#at t#e !o&!ams +ill !ed(ce t#e incentive to self-deo!t $ased

on t#e !ovision of +o!* a(t#o!i7ation and t#e !emoval of fea! of deo!tation.

1'. DACA and DAPA may also infl(ence t#e decisions of otential mi&!ants

and ot#e! (na(t#o!i7ed immi&!ants al!eady !esent in t#e nited 8tates.

8ecifically, t#ese individ(als may $e enco(!a&ed $y t#ese !o&!ams to immi&!ate

+it#o(t a(t#o!i7ation o! to !emain in t#e nited 8tates $eca(se of a otential a$ility

to !eceive an ad>(stment desite a fail(!e to


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1. %n s#o!t, t#e effect of DACA and DAPA is to incentivi7e !esidents of

ot#e! co(nt!ies to come to t#e nited 8tates. #e olicies also enco(!a&e individ(als

+#o a!e al!eady !esent in t#e nited 8tates to !emain +it# t#e #oe t#at t#ey +o(ld

#ave a f(t(!e ad>(stment of stat(s. ased on my ed(cation,


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in t#e la$o! ma!*ets of a!eas +#e!e t#e o(lation +as concent!ated, +#ile en#anced

enfo!cement +o(ld !ed(ce f(t(!e &!o+t# of t#e o(lation.11

22.

%n t#e 25 yea!s afte! %3CA +as imlemented, t#e!e #as not $een a

si&nificant dec!ease in t#e n(m$e! of (na(t#o!i7ed immi&!ants ente!in& t#e nited

8tates. %nstead, t#e (na(t#o!i7ed o(lation #as s(!&ed to 11.@ million individ(als

since its imlementation. =(!t#e!, a!!en and a!!enFs estimates imly a &!o+t#

of '.5 million $et+een 10 and 200@, nea!ly times t#e le&ali7ed o(lation at t#e

time %3CA +as assed.12

2.

"val(ations of t#e imact of %3CA #ave concl(ded t#at t#e !o&!am

failed to accomlis# its &oals.1 #e !esident (na(t#o!i7ed immi&!ant o(lation +as

initially !ed(ced t#!o( ad>(stments in stat(s $(t s($seecto!y of &!o+t#, as !eflected in a$le 1. Many analysts concl(ded t#at

t#e !incial !est!(ct(!in& t#at occ(!!ed in !esonse to %3CA +as lon&e! so>o(!ns o!

e!manent s#ifts of !esidence in t#e nited 8tates $y e!sons +#o +o(ld #ave

ot#e!+ise #ave sent la!&e! o!tions of time in t#ei! co(nt!y of o!i&in.14 #is flo+ of

(na(t#o!i7ed ent!ants ac!oss t#e $o!de! +as !esonsive to many infl(ences,

11

Beff!ey 8. Passel et al., Undocumented Migration Since $'CA: An 2erallAssessment, in NDCM"N"D M%63A%N " N%"D 8A"8: %3CA AND "

"P"3%"NC" = " 1'08251-2?4 /=!an* D. ean et al. eds., 10).12Seea!!en a!!en, su&ranote 4.1at#a!ine M. Donato et al., Stemming the Tide5 Assessing the eterrent Effects of

the $mmigration 'eform and Control Act, 2 D"M63AP 1 /12); !!eni(s Havodny,

su&ranote @.14elinda %. 3eyes et al., P($. Policy %nstit(te of Cal., 6olding the ine5 The Effect of

the 'ecent order uild3U& on Unauthori#ed $mmigration/2002).

pp. 0761


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1

incl(din& !ima!ily e!cetions of !elative emloyment oo!t(nities and +a&e

!ates.15

24.

ne so(!ce of data (sed to eval(ate t!ends in (na(t#o!i7ed immi&!ation

flo+s is t#e time se!ies of a!e#ensions of e!sons attemtin& ent!y +it#o(t

a(t#o!i7ation. #e inte!!etation of t!ends in a!e#ension data is not

st!aitfo!+a!d.1? =o! eamle, an inc!ease in a!e#ensions may !eflect an

inc!eased vol(me of attemted (na(t#o!i7ed ent!y, o! it may !eflect a c#an&e in t#e

effectiveness of $o!de! enfo!cement o! in t#e efficiency of sm(&&lin& oe!ations in

t!anso!tin& (na(t#o!i7ed immi&!ants ast $o!de! s(!veillance +it#o(t detection.

A!e#ension and !omt !emoval of e!sons +#o attemt ent!y may inflate

a!e#ension co(nts !elative to t#e vol(me of e!sons +#o s(ccessf(lly ente! t#e

nited 8tates ille&ally if (na(t#o!i7ed immi&!ants ma*e !eeated attemts to ente!

(ntil t#ey a!e s(ccessf(l. Analysts #ave identified some of t#ese confo(ndin&

infl(ences on t!end data on immi&!ations, and find it (sef(l to identify t!ends in

mi&!ation flo+s, +it# allo+ance fo! confo(nde!s.1@

25. #e n(m$e! of (naccomanied c#ild!en /AC) a!e#ensions #as

inc!eased in t#e ast si yea!s and #as s(!&ed in t#e last t+o yea!s. At t#e time

DACA +as initiated, t#e yea!ly total fo! $o!de! a!e#ensions of AC in = 2012

15anson, su&ranote ?; anson 8ilim$e!&o, su&ranote ?41?#omas B. "sens#ade, Using $S order A&&rehension ata to Measure the -lo!

of Undocumented Migrants Crossing the U4S43Me"ico -rontier, 2 %NFE M%63A%N 3"9. 545

/15).1@anson 8ilim$e!&o, su&ranote ?; ean et al., su&ranote 1.

pp. 0762


15/42pp. 0763


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ent!y ost-DACA leads, at minim(m, to t#e concl(sion t#at t#e!e is no evidence t#at

DACA olicy #as cont!i$(ted to a dec!ease in (na(t#o!i7ed immi&!ation. ne of t#e

stated (!oses of t#e olicy #as $een to !edi!ect t#e enfo!cement activities of t#e

Dea!tment of omeland 8ec(!ity to #ie! !io!ity activities. (t >(st t#e !eve!se

#as occ(!!ed. #ile DACA #as not $een s#o+n to $e t#e !incial ca(se of t#e s(!&e,

it is !easona$le to #yot#esi7e t#at it #as cont!i$(ted to a climate of eectations

amon& e!sons contemlatin& an (na(t#o!i7ed ent!y t#at stat(s ad>(stments may

$e availa$le to !esident (na(t#o!i7ed c#ild!en.

2@.

A conse!vative s(mma!y of t#e stat(s ad>(stment !ovisions of %3CA

and DACA is t#at t#e!e is no t#eo!etical $asis o! emi!ical evidence t#at s(c# an

ad>(stment cont!i$(tes to a !ed(ction of f(t(!e (na(t#o!i7ed ent!y o! o(lation

&!o+t# ecet fo! t#e $oo**eein& ad>(stment of !eclassifyin& some (na(t#o!i7ed

ent!ants and !esidents as a(t#o!i7ed. %t seems vi!t(ally ce!tain t#at t#e +o!*

a(t#o!i7ation and defe!!al of deo!tation +o(ld #ave a di!ect effect of dec!easin&

vol(nta!y !et(!n and deo!tation, +it# t#e effect of inc!easin& t#e si7e of t#e !esident

(na(t#o!i7ed o(lation in eas and t#e nited 8tates.

2'. #e!e is also !easona$le t#eo!etical &!o(nd fo! $elievin& t#at $ot# t#e

demonst!ation effect to f(t(!e otential (na(t#o!i7ed ent!ants of !eeated ost #oc

stat(s ad>(stments, as +ell as t#e eansion of an a(t#o!i7ed !esident o(lation

t#at may anc#o! f(t(!e (na(t#o!i7ed immi&!ation, +o(ld #ave t#e eected effect of

inc!easin& s($se


17/42

1?

is t#at stat(s ad>(stment !o&!ams #ave !eceded inc!eases !at#e! t#an dec!eases of

stoc*s and flo+s of (na(t#o!i7ed immi&!ation.

VII. U#au!h"(i&- I**i+(a#!$ R&&i8& a Di$%("%"(!i"#a!& A*"u#! "f

U#"*%$a!&- H&al!ha(&

2. #e!e is s($stantial evidence t#at (na(t#o!i7ed immi&!ants #ave fe+

oo!t(nities fo! sonso!ed #ealt# ca!e t#!o(o(t t#e nited 8tates. 3ates of

!ivate ma!*et ins(!ance a!e lo+ amon& (na(t#o!i7ed o(lations. A !ecent st(dy

com$inin& info!mation f!om t#e Cens(s (!ea(Fs 8(!vey of %ncome and P!o&!am

Pa!ticiation and Ame!ican Comm(nity 8(!vey estimated t#at @1 of (na(t#o!i7ed

immi&!ant ad(lts lac*ed any fo!m of #ealt# ins(!ance,1'a findin& t#at is conco!dant

+it# mo!e di!ect s(!vey estimates fo! !e&ional and local s($-o(lations.1

0. na(t#o!i7ed immi&!ants do not (se #ealt#ca!e at #i !ates.

na(t#o!i7ed immi&!ants aea! to #ave lo+e! !ates of mo!$idity t#an .8. native

o(lations. #is is a common findin& fo! immi&!ant o(lations $eca(se mi&!ation

is f!eoin immi&!ation st!eams. %t is also li*ely t#at oo!e! access to ca!e means t#at

(na(t#o!i7ed immi&!ants a!e mo!e li*ely to #ave (ndia&nosed conditions, and #ence

fail to !esent fo! t!eatment.20

1'

3andy Cas et al., Mi&!ation Policy %nst., A emogra&hic, Socioeconomic, and6ealth Co2erage %rofile of Unauthori#ed $mmigrants in the United States/May 201).

1Dana P. 6oldman et al., egal Status and 6ealth $nsurance Among $mmigrants, 24

"AEA==. 1?40 /2005).20 8ilvia elena a!cellos et al., Undiagnosed isease, Es&eciall) iabetes, Casts

oubt on Some of the 'e&orted 6ealth ;Ad2antage< of 'ecent Me"ican $mmigrants, 1

"AEA==. 2@2@ /2012); assim a!!af et al., Emergenc) e&artment Ser2ice Use Among

$mmigrant and on3$mmigrant =rou&s in the United States, 1? B.%MM%63AN M%N3%

"AE55 /2014).

pp. 0765


18/42

1@

1. #en t#ey do &et sic*, immi&!ants a!e less li*ely to see* medical ca!e

t#an ot#e! o(lations $eca(se of lo+e! !ates of #ealt# ins(!ance cove!a&e and ot#e!

$a!!ie!s to ca!e.21 #e one ecetion to t#is atte!n of lo+e! #ealt# ca!e (se is t#at

(na(t#o!i7ed immi&!ants (se a #ie! vol(me of se!vices t#an most ot#e!

o(lations fo! la$o! and delive!y.22

2. #en t#ey do (se #ealt#ca!e, (na(t#o!i7ed immi&!ants

dis!oo!tionally (se (ncomensated ca!e. sin& an alication of t#e !esid(al

met#od desc!i$ed a$ove to c!eate estimates of (na(t#o!i7ed immi&!ant o(lations

to data f!om t#e Medical "endit(!e Panel 8(!vey, P!ofesso! 8timson and

collea&(es estimated t#at $et+een 2000 and 200, (na(t#o!i7ed immi&!ants +e!e

mo!e t#an t+ice as li*ely as .8. natives to (se (ncomensated ca!e, and #ad #ie!

!ates of (se of (ncomensated ca!e t#an all ot#e! immi&!ant stat(s &!o(s.2

21Ma!c E. e!* Cla(dia E. 8c#(!, The Effect of -ear on Access to Care Among

Undocumented $mmigrants, B.%MM%63AN "AE151 /2001); Ma!c E. e!* et al., 6ealth

Care Use Among Undocumented atino $mmigrants, 1 "AEA==. 51 /2000); at#!yn

De!ose et al., $mmigrants and 6ealth Care: Sources of >ulnerabilit), 2? "AEA==. 125'/200@).

22e!* et al., su&ranote 20; C. Annette D(a!d Ma!* . Massin&, Trends in

Emergenc) Medicaid E"&enditures for 'ecent and Undocumented $mmigrants, 2@ B.AM.

M"D.A88FN 10'5 /200@).2 Bim P. 8timson et al., Unauthori#ed $mmigrants S&end ess Than ther

$mmigrants and US ati2es on 6ealth Care, 2 "AEA==. 11 /201); Bim P. 8timson

et al., E >isits and S&ending b) Unauthori#ed $mmigrants Com&ared /ith egal

$mmigrants and US ati2es, 2 AM B."M"36"NC M"D. ?@ /2014).

pp. 0766


19/42

1'

Tal& 10 H&al!h Ca(& S%-i#+ ) Na!i8i!) A#- L&+al S!a!u$ Of

R&$%"#-!$ T" Th& M&-ial E9%-i!u(& Pa#&l Su(8&), 3555654

S!a!u$

:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

U#au!h"(i&- L&+al Na!u(ali&-

I**i+(a#! (&$i-! i!i US #a!i8&

PERCENTOFPOPULATIONHAVIN;0

Any #ealt# ca!e eenses ?0 @2 ' '@

Any (ncomensated ca!e 5. 4.@ 2. 2.'

EXPENDITURES

Ave!a&e ann(al /millions

of 200 O) 15,@0 2',4@ 52,?21 1,02',22

Pe!cent of 8 eendit(!es 1.4 2.5 4.@ 1.4

8o(!ce: 8timson et al., Unauthori#ed $mmigrants S&end ess, su&ranote 2 /".1).

. ealt# ca!e !ovide!s in states, incl(din& eas, t#at #ave a

dis!oo!tionate $(!den of !esident (na(t#o!i7ed o(lations, #ave a

dis!oo!tionate $(!den of !ovidin& (ncomensated ca!e. "stimates f!om t#e

!esid(al met#od !esented in a$le 1 a$ove a!e t#at t#e (na(t#o!i7ed immi&!ant

o(lation in eas is $et+een 1.?5 and 1.' million as of 2012. #e eas ealt#

and (man 8e!vices Commission /8C) #as estimated t#at t#e 8tateFs ($lic

#osital dist!ict facilities inc(!!ed a!oimately O5?.' million in (ncomensated

ca!e fo! (na(t#o!i7ed immi&!ants in = 200? and O@1?.' million in = 200'.24

4.

#ese (na(t#o!i7ed immi&!ants dis!oo!tionally !eside in a fe+

>(!isdictions, incl(din& t#e a!!is Co(nty ealt# Dist!ict and Dallas Co(nty ealt#

Dist!ict. As a !es(lt, t#ese >(!isdictions #ave a dis!oo!tionate $(!den of

24 e. ealt# (man 8e!vs. CommFn, 'e&ort to the United States Congress on

Ser2ices and enefits %ro2ided to Undocumented $mmigrantsat 4-10 /200') /8C 200'

3eo!tQ); e. ealt# (man 8e!vs. CommFn, 'e&ort on Ser2ices and enefits %ro2ided to

Undocumented $mmigrantsat ?-12 /2010) /8C 2010 3eo!tQ)

pp. 0767


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1

(ncomensated ca!e. =o! eamle, o(t of t#e estimated O5?.' million in

(ncomensated ca!e !ovided to (na(t#o!i7ed immi&!ants $y ($lic #osital

facilities in = 200?, a!oimately O215.4 million +as inc(!!ed at a!!is Co(nty

facilities and O14.@ million +as inc(!!ed at Dallas Co(nty facilities.25 (t of t#e

estimated O@1?.' million in (ncomensated ca!e !ovided to (na(t#o!i7ed

immi&!ants $y ($lic #osital facilities in = 200', a!oimately O2.@ million +as

inc(!!ed at a!!is Co(nty facilities and [email protected] million +as inc(!!ed at Dallas Co(nty

facilities.2?

5.

na(t#o!i7ed immi&!ants !esidin& in eas also !eceive #ealt#ca!e

se!vices and $enefits f!om seve!al ($lic !o&!ams t#!o( t#e 8tateFs 8C. =o!

eamle, (na(t#o!i7ed immi&!ants a!e eli&i$le fo! eas "me!&ency Medicaid, +#ic#

!ovides Medicaid cove!a&e limited to eme!&ency medical conditions, &ene!ally

defined to mean conditions t#at, in t#e a$sence of immediate medical attention, co(ld

!easona$ly $e eected to lace t#e atientFs #ealt# in se!io(s >eoa!dy o! ca(se

se!io(s imai!ment o! dysf(nction to t#e atientFs $odily f(nctions o! o!&ans.2@

Acco!din& to !eo!ts comiled $y 8C, t#e total estimated cost to t#e 8tate fo! t#e

!ovision of "me!&ency Medicaid se!vices to (na(t#o!i7ed immi&!ants !esidin& in

eas +as a!oimately O'0 million in = 200@, O?2 million in = 200, and O@1

million in = 2011.2'

258C 200' 3eo!t, su&ranote 24, at ?-10.2?8C 2010 3eo!t, su&ranote 24, at '-12.2@e. ealt# (man 8e!vs. CommFn, eas o!*s and$oo* /2014) /&lossa!y),

a2ailable at #tt:LL+++.dads.state.t.(sL#and$oo*sLeaso!*sL&lossa!yLinde.#tmRemc.2'8C 200' 3eo!t, su&ranote 24, at ; 8C 2010 3eo!t, su&ranote 24, at 4;

e. ealt# (man 8e!vs. CommFn, 'e&ort on Te"as 6ealth and 6uman Ser2ices

pp. 0768


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20

?. na(t#o!i7ed immi&!ants also may $e entitled to !eceive eas

C#ild!enFs ealt# %ns(!ance P!o&!am /C%P) Pe!inatal Cove!a&e, +#ic# !ovides

!enatal ca!e fo! t#e (n$o!n c#ild!en of +omen +#ose income is ( to 200 fede!al

ove!ty level and +#o do not


22/42

pp. 0770


23/42

Appendix 1 to

Declaration of Karl Eschbach, Ph. D.

pp. 0771


24/42

Date: 12/2014

CURRICULUM VITAE

NAME: Karl Eschbach

PRESENT POSITION AND ADDRESS:

Professor and Director of Population Research,

Department of Internal Medicine, Division of Geriatricsniversit! of "e#as Medical $ranch

%01 niversit! $lvd&

Galveston, "' (()))*01((

+aescha-utm&edu

.40 2*0 3ffice

.40 %2*1(( Moile

EDUCATION:

2001*2002 I5 6ello7, 8ealth of 3lder Minorities, "M$ 9eal! enter on 5;in;

1%*1) I8D post*doctoral fello7ship, enter for Demo;raph! and une 14 $&5& summa cum laudein 9ociolo;!, niversit! of Penns!lvania, Philadelphia, P5

PROFESSIONAL AND TEACHING EXPERIENCE:

2010* Professor .7ith tenure Department of Internal Medicine*Geriatrics?

200(*2010 5ssociate Director, Institute for Demo;raphic and 9ocioeconomic Research, niversit! of "e#as

at 9an 5ntonio .Interim Director, 200(*200(*2010 5ssociate Professor to Professor, Department of Demo;raph!, niversit! of "e#as at 9an

5ntonio

200%*200( 5ssociate Professor, Department of Internal Medicine*Geriatrics @

Graduate 9chool of $iomedical 9ciences, Department of Preventive Medicine and

ommunit! 8ealth, niversit! of "e#as Medical $ranch, Galveston

1 Aisitin; 5ssistant Professor, Dept& of 9ociolo;!, Rice niversit!

1)B2004 5ssistant to 5ssociate Professor, Department of 9ociolo;!, niversit! of 8ouston

1) Cecturer, Dept& of 9ociolo;!, niversit! of =isconsin, Madison&

12*1% Cecturer, ommittee on 9ocial 9tudies? Research 6ello7, Malcolm =iener enter for

9ocial Polic!, enned! 9chool of Government, 8arvard niversit!

HONORS

niversit! of Penns!lvania, $&5& a7arded summa cum laude? $enEamin 6ran+lin ational 9cholar, 14

Research 5ssociate, enter for Immi;ration Research, niversit! of 8ouston, 1*2004

Memer,


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2

9enior Research 5ssociate, niversit! of 8ouston, enter for Pulic Polic!, 9eptemer 200(*

DeanFs 57ard for Research < .PI /%0/201%*/%0/2014 &0 al Mnths

5rchivin; 6our e7 Datasets from the Con;itudinal 8ispanic


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3

Co&%le#e' Gra"#$Co"#rac# S!%%or#

1R01 51%42() Good7in, > .PI 0(/1(/200 B 0/%0/201% 1&20 cal mths

I8 2)0,000

nderstandin; Mechanisms of


27/42

4

Methodist 8ealthcare Ministries

Pro,ections of -besity and %iabetes Pre&alence for Counties in Texas& /200(*2/200

Role: Principal investi;ator .5ssumed from ;rant to 9teve 8& Murdoc+

R21 5"0024 ational enter for omplementar! and 5lternative MedicineCM Use in Hispanics ./0 1ears -ld in US 2 Mexico.>ose Coera, MD, PI %/200)*2/200(

Role: o*investi;ator

Grant L 4%& 8o;; 6oundation for Mental 8ealth, 5ustin, "e#as&

Psychological distress among Mexican3origin populations in the United States4

2002*200%

Role: Principal investi;ator&

nited 9tates& Department of the Interior& Minerals Mana;ement 9ervice&

The 'mpact of -uter Continental Shelf cti&ity on Selected Communities and 'nstitutions on the 5ulf

Coast4 .>ohn Petterson, PI 1*2001Role: o*investi;ator

"rull 6oundation, Palacios "e#as&

Migrant %eath at the US 3 Mexico 6order.estor Rodr;ueK, PI 1)*1(

Role: o*investi;ator

TEACHING

Co!rses Ta!(h#

5;in;

8ealth Promotion

Introductor! 9ociolo;!

Political 9ociolo;!

Population/demo;raphic techniNues

Racial and ethnic relations

Research methods

9ocial


28/42

5

ushan; Patel .2002*4 "M$, Preventive Medicine @ ommunit! 8ealth

Rosa Davla .200%*( niversit! of "e#as*8ouston, 9chool of Pulic 8ealth

>& 6red "homas .2004*( "M$, Preventive Medicine @ ommunit! 8ealth .hair

6ran+ Cemus .2004*( "M$, Preventive Medicine @ ommunit! 8ealth

$ret 8o7re! .200* "M$, Preventive Medicine @ ommunit! 8ealth

Mar! $ollin;er .200*10 "95, Demo;raph! and 3r;aniKation 9tudies

"hu!!unh Do .2011*201% "M$, Preventive Medicine @ ommunit! 8ealth5l!ssa 9hell .2012*201% "M$, Preventive Medicine @ ommunit! 8ealth

Ca7rence Panas .2011*201% "M$, Preventive Medicine @ ommunit! 8ealth .hair

itha Mathe7 .201%*2014 "M$, 9chool of ursin;

Proess)o"al Ser*)ce

9tate of "e#as representative to 9& $ureau of the ensus 9tate Data enter Pro;ram, 6ederal*9tate

ooperative on


29/42

6

5merican Pulic 8ealth 5ssociation

Gerontolo;ical 9ociet! of 5merica

Population 5ssociation of 5merica

Population Reference $ureau

.OURNAL$GRANT REVIE/ER:

ournal of


30/42

7

)&

M, Rodri;ueK P, a+os 5& 8ouston 8ei;hts Cityscapes41? 4.2:24)*2)&

&

9& ei;horhood omposition and Incidence of ancer

amon; 8ispanics in the nited 9tates& Cancer& 200)? 10%.):10%*1044&

1& $ratter >C,


31/42

8

22&

5l 9nih 9, 3ttenacher >, Mar+ides 9, uo O6, 9& "he P, >u 8, RaEi M, u 8, , Curie , 6lac+ >M, Mattei >&, 5,

6urumoto*Da7son 5, 8an+in >R, DeGraffinreid, & 5dvancin; the 9cience of 8ealth Disparities

Research& Ethnicity 2 %isease4 200(? 1(.%:42(*4%%&2&

"ovar >>, 5n;el R>, , ital and Health Statistics& 9eries 2,

umer 14, 3ctoer 200&

pp. 0779


32/42

9

%&

Cac+an , P, 6reeman >C, Good7in >9& 9& orrelates of $acterial

Pneumonia 8ospitaliKations in P, =ilson 6,


33/42

10

)4&

9hell, 5M, Pee+ M, 9, 6reeman >C,


34/42

11

4&


35/42

12

,oo4 Re*)e0s

1& The Micro3Macro "in$&&& 5le#ander et al& .$er+ele!: niversit! of alifornia Press& 1( in

ualitative 9ociolo;! 12.4:42(*42? 1&

2& Micro3Sociological Theory& & 8elle and 9&& ournal? 200%&

Prese"#a#)o"s a# Co"ere"ces$U")*ers)#)es

1&


36/42

13

Department of 8ousin; and ran Development =or+in; Group meetin; on X9ustainin; Diverse

ran ommunities,Y Co!ola niversit! of hica;o, 1&

11&


37/42

14

estenaum $, Meetin; or;aniKers&

%0&

utchin M, ul! 2, 200)&

&

urrent population trends in "e#as& " 9chool of Ca7 C< 9!mposium, 5ustin, "', ovemer ,200(&

(& Demo;raphic trends in post*secondar! enrollment& ational 5ssociation of 9tate "reasurers, 9an

5ntonio, "', Decemer %, 200(&

& Prospectus for a ative 5merican 8ousin; eeds 5ssessment& ational 5merican Indian 8ousin;

ouncil 5nnual Meetin;, Cas Ae;as, A, Decemer ), 200(&

& Population chan;e in "e#as& "o and from 2000& "e#as Monthl!


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15

1)&

Impacts of ille;al immi;ration on "e#as and the "e#as econom!& Dallas 6rida! Group, 5pril 11,

200&

1& urrent research on health and healthcare issues of 8ispanic population in "e#as& 9an 5ntonio

5ssociation of 8ispanic >ournalists& 9an 5ntonio, "', 5pril 12, 200&

1(& urrent trends of population chan;e in "e#as& "e#as 5ssociation of ran ounties, Roc+7all,

"'& 5pril 24, 200&

1&

"e#as 9tate Data enter 5nnual Meetin;, 5ustin, "', Ma! (, 200&1& Invited testimon! on current trends in population chan;e in "e#as affectin; 7or+force rene7al&

8ouse 9elect ommittee on 8i;her and Pulic une 2%, 200&

2& urrent population trends in "e#as& "e#as Department of Insurance, Propert! asualt! Division,

5ustin, "', >une 2), 200&

2(& Invited testimon! on population trends affectin; healthcare 7or+ force needs in "e#as& Invited

testimon! to Eoint 8ouse committees on International and $order 5ffairs, Pulic 8ealth, and

5ppropriations, Representatives "rac! in;& Dianne =hite Delisi, R!an Guillen, hairs& 5ustin,

"', >une %0, 200&

2& urrent population trends in "e#as and ph!sician 7or+force rene7al& "e#as 8ealth are Polic!

ouncil, Partnership 9ucommittee& 5ustin, "', >ul! 1, 200&

2& Invited testimon! on population trends affectin; non*metropolitan "e#as& 9enate ommittee on

International Relations and "rade, 9enator r&, hair, 5ustin, "', 5ustin "', 5u;ust

1%, 200&

%0&

"rends in population affectin; the rene7al of the "e#as 7or+force, "e#as =or+force Investment

ouncil& 5ustin, "', 9eptemer ), 200

%1&

urrent trends in population chan;e in "e#as and 9an 5ntonio& MasterFs Ceadership 6orum,

3ctoer 1, 200&

%2& urrent trends in population chan;e in "e#as and the apitol Re;ion& Geor;eto7n Rotar!,

3ctoer %, 200&%%& Invited testimon! on indi;ent health care& "e#as 8ouse ommittee on Pulic 8ealth, >odie

Cauener;, hair& 3ctoer 1%, 200

%4& urrent trends in population chan;e in 9outheast "e#as& Ceadership 9outheast "e#as& 3ran;e,

"', 3ctoer 2%, 200&

%)& Population chan;e and 7or+force rene7al in the "e#as Panhandle Re;ion& 5marillo, "', 3ctoer

pp. 0786


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16

%1, 200&

%&

Population han;e and 8ealth and 8ealthcare eeds in "e#as& 9an 5ntonio 8ispanic hamer of

ommerce& "hird 5nnual 8ealthcare 9ummit and =ellness anuar! , 200&

4)&

urrent trends of population chan;e in "e#as and the 3R"


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17

)&

urrent "rends of han;e in the Population of "e#as and Re;ion %& Re;ion % ul! (, 200&

2&

urrent Demo;raphic "rends and the 6uture of "e#as& Masters Ceadership Pro;ram, 9an5ntonio& 3ctoer , 2010

%& 8ispanics in the nited 9tates and "e#as in an une 2, 2012&

4& Galveston it! Population, =or+force and 8ousin;, 10*2010&

a& Gulf oast Interfaith, Galveston, "'& 9eptemer 2011&

& Galveston ount! Mutual 5ssistance Partnership, >anuar! 2012&

c&

Rotar! of Galveston Island, Galveston, "' 6eruar! 2012&

d&

6amil! 9ervice enters of Galveston ount!& Dic+inson, "', March 2012&

e&

Galveston 6oundations Roundtale, Decemer, 201%&

pp. 0788


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Appendix 2 to

Declaration of Karl Eschbach, Ph. D.

pp. 0789


42/42

List of Karl Eschbachs Depositions/Testimonies in the Past Four Years

State v. Leon Davis

Cause Nos. 13-01-00685-CR; 13-05-05517-CR

9th Judicial District Court, Mot!o"er# Cout#, $e%asDate o& $esti"o#' Ma# (1, (01)

Exhibit 14 - Declaration of Karl Eschbach, Ph.D.

Documents

Transcript of Exhibit 14 - Declaration of Karl Eschbach, Ph.D.